For a diabetic patient, it is the blood sugar levels which reveal whether they have either high amounts of blood sugar (hyperglycaemia) or low blood sugar levels (hypoglycaemia)
Worried about your fluctuating levels of blood sugar? Well, don’t be. Here are six pointers from Dr Ganesh Kadhe, associate director, nutrition medical and scientific affairs, Abbott, on how you can gain control over your sugar levels and stay healthy even with a diabetic condition.
Eat right and exercise regularly
Your food choices matter a lot when you’ve got diabetes. Some are better than others. Eat something every 2½ to 3 hours and main meals no longer than four-five hours apart. Eating meals and snacks at consistent times help keep your blood glucose levels within target range. Include low Glycemic index (GI) foods like whole wheat, brown rice, oats, etc. in every meal. Avoid refined cereal products like white bread, noodles, white rice, etc. as they can raise blood sugar levels. Getting regular physical exercise is equally important to maintain normal blood sugar levels. But check your blood sugar levels before and after exercise and avoid exercising if your blood sugar levels are too high or too low.
Control your cholesterol levels
Diabetes tends to lower “good” cholesterol levels and raise triglyceride and “bad” cholesterol levels, which increases the risk for heart disease and stroke. High cholesterol also leads to a common complication of diabetes known as diabetic dyslipidemia which may result in clogged arteries and coronary complications. Ideally, stay away from a diet high in saturated and trans fats such as fast food – burgers, pizza, fried snacks as these raise your LDL cholesterol.
Check your blood sugar levels regularly
For a diabetic patient, it is the blood sugar levels which reveal whether he/she has either high amounts of blood sugar (hyperglycaemia) or low blood sugar levels (hypoglycaemia) in the blood. Both are extremely dangerous. The best way to check your blood sugar levels at regular intervals is to have a glucometer at hand. Get your HbA1C checked twice a year. HbA1C (Haemoglobin A1C) is a simple blood test that measures how well your diabetes is managed over time. It is aimed at measuring your average blood sugar levels and to see if it has stayed within the required range. It is important to get this test done either twice a year or once in three months depending on how well your diabetes is controlled.
Check your blood sugar levels before and after exercise and avoid exercising if your blood sugar levels are too high or too low. (Representational image/Pixabay)
Be regular with your medication
Adherence to the prescribed medication at the recommended amount and schedule is important for having a good diabetic control. Missing medication can increase your risk of suffering from several diabetes-related health complications.
Add a diabetes-specific formula
Along with lifestyle modifications and regular exercise, it is advised to add a diabetes-specific formula to your diet plan. Look for a formula that is designed with special ingredients like complex carbohydrates, vitamins and anti-oxidants, to help manage steady release of glucose. Ideally, the formula must be included in your breakfast, lunch or dinner as partial meal replacement in one of your modified meals. It helps to keep blood glucose and weight under control.
Shed those extra pounds
Obesity is one of the most crucial mitigating factors of diabetes. Obesity also causes your cholesterol levels to skyrocket, increasing the chances of heart disease.
So-called “diabetes diets” have come a long way since the discovery of insulin in 1921, yet common themes underlying many eating plans today were first developed by registered dietitians more than a century ago, according to two speakers.
Melinda D. Maryniuk
“Nutrition is not something new that we are just beginning to pay attention to,” Melinda D. Maryniuk, MEd, RDN, CDCES, FADA, senior consultant with Melinda Maryniuk & Associates in Boston, told Healio. “Back in the 1920s, people were already focusing on cultural foods and individualized diets in diabetes. As dietitians, we act like we are doing this for the first time. It is helpful to look back in history and realize that there was great work that was laid before us, and there are some things we should learn from.”
Diets before, after insulin
Prior to the discovery of insulin in 1921, regulating food intake — typically severely limiting carbohydrate and calories — was the only treatment for type 1 diabetes, Maryniuk said during a virtual presentation at the American Diabetes Association Scientific Sessions.
In 1915, Frederick M. Allen, MD, first wrote about “total dietary regulation” in the treatment of diabetes, noting that a very low-carbohydrate/low calorie diet was the best way to “clear glucose from the urine and extend life.”
The approach included three steps:
Strict calorie reduction for 1 to 4 days, with a diet alternating coffee and whiskey (1 oz every 2 hours) until the urine was “free of sugar;”
Preparing “thrice boiled vegetables” for 1 to 3 days; and
A gradual addition of protein and fat to avoid a fast rise in glucose.
“Whiskey is not essential — it merely furnishes calories and keeps the patient comfortable,” the text states.
Insulin was heralded as a “miracle” cure, allowing children to consume enough calories to return to a healthy weight. Yet even in insulin’s early days, Elliott Joslin stressed the important of the “treatment triad” for diabetes management: insulin, exercise and diet, and the challenge to “get all three to work together,” Maryniuk said. Joslin was a proponent of the weighted diet in the post-insulin era.
“It was very restricted in terms of the kinds of foods allowed — how much grapefruit, how much orange, potato, oatmeal and cream one could have,” Maryniuk said. “In one of the Joslin books, grapefruit and oranges were the only recommended fruits in the early years. It said, ‘What should a diabetic do if given an apple?’ The answer was, ‘Throw it away.’”
Joslin diets included lists for food values every clinician was expected to memorize, Maryniuk said. Early plans were tightly structured, though diets became progressively more adapted and individualized, allowing for variation in quantity and food type. Still, other clinicians recommended very different diabetes eating plans, and there was debate on the optimal eating plan for diabetes.
“I visited Camp Joslin several times in the late 1970s as a new dietitian,” Maryniuk said. “I remember the boys taking their peaches from lunch, carving off the flesh, and weighing them on the gram scale until they had the precise amount they were prescribed, usually about 150 g. And then I moved to Florida, and their approach to meal planning at a diabetes camp there was so different. Healthy foods were served family style, kids selected what their appetite dictated. I realized then that there was no one approach to meal planning.”
Source: Adobe Stock
Edward Tolstoi, MD, best known for advocating “the free diet,” recommended a diet that did not include a gram scale. People with diabetes could choose foods that do not differ from the diet consumed by other family members, as long as choices were healthy. Many other clinicians also pushed for an increase in carbohydrates to allow for a more normal life as early as 1933, Maryniuk said.
The Exchange Lists for Diabetes Meal Planning bookletwas first published in 1950 by the Academy of Nutrition and Dietetics, the ADA and the U.S. Public Health Service Diabetes Branch to address a need for standardization in food values and terminology and to simplify nutrition messages. Even in 1950, individualized plans that “suit the special needs” of the person with diabetes were highlighted, Maryniuk said.
Individualized plans key
Today, the message of individualized nutrition therapy has become central, Hope Warshaw, MMSc, RD, CDE, BC-ADM, FADCES, said during the presentation, where she shared nutrition history from the 1980s into the future. Knowledge gained from the U.K. Prospective Diabetes Study (UKPDS), U.S. government food and nutrition polices, and the role of registered dietitians and registered dietitian nutritionists pushing the field forward have kept a focus on a critical need for person-centred care, Warshaw said.
Hope Warshaw
“While over the years since the 1980s there have been tweaks made in the macronutrient recommendations — particularly carbohydrate and fat — and the addition of recommendations regarding the types of fats to consume and not consume, a consistent message has been to consider all elements of the person’s lifestyle, life schedule and eating habits,” Warshaw, owner of Hope Warshaw Associates, LLC, a nutrition and diabetes-focused consultancy based in Asheville, North Carolina, told Healio.
That message is even stronger in the ADA’s 2019 nutrition therapy consensus report, which states individual nutrition needs should be based on personal and cultural needs, literacy, numeracy, access to healthy foods, willingness and ability to make behaviour changes and understanding a person’s barriers.
“Another important statement to guide our recommendations was added to the ADA nutrition recommendations in 2013,” Warshaw said. “That is, in clinician guidance, strive to maintain the pleasure of eating, limiting food choices only when indicated by scientific evidence.”
Eating habits are a challenge to change, Warshaw said; clinicians should strive to work with people from where they are and how they eat. She outlined four “common denominators” of healthy eating patterns, highlighted in the 2019 consensus report:
Emphasize consumption of non-starchy vegetables;
Minimize consumption of added sugars and refined grains;
Choose whole foods over highly processed foods; and
Replace sugar-sweetened beverages with water as often as possible.
“There is great interest in food, nutrition and eating patterns today,” Warshaw told Healio. “I expect that with continued interest and exploding research in this area, new findings for the general public as well as for people with different types of diabetes will impact future guidance. Areas to watch are the role of the gut microbiome in glycaemic dysfunction and potential management, precision nutrition for diabetes care, optimizing artificial intelligence and machine learning to ease management burdens, and optimized strategies and programs, like online coaching platforms, to support necessary behaviour changes to achieve positive outcomes.”
Find out how clean eating can help you and your baby thrive
As if expectant parents don’t have enough to worry about, add a type of diabetes that seems to be tailor-made for pregnancy. But if you’ve been diagnosed with gestational diabetes, take heart. Diabetes during pregnancy is very manageable — often without medication.
“Many people can manage the condition with a gestational diabetes diet and lifestyle changes,” says diabetes educator and registered nurse Megan Asterino-McGeean, BSN, RN, CDCES. “But if you do need medication, it’s not a sign of failure or that you did something wrong. Each pregnancy is unique and has its own needs.”
Asterino-McGeean teams up with registered dietitian Tegan Bissell, LDN, CDCES, to share the best tips, tricks and insights about following — and sticking to — a gestational diabetes diet plan.
What is gestational diabetes?
Gestational diabetes is a type of diabetes that occurs during pregnancy. It usually develops when you are 24 to 32 weeks pregnant and disappears after delivery. But it’s possible to develop gestational diabetes before or after this time frame.
"Insulin's job is to keep our blood sugar levels on target. But during pregnancy, your placenta makes hormones that prevent insulin from working as well as it should,” explains Asterino-McGeean. “High blood sugar levels can be dangerous. There are possible risks and complications for you and your baby if sugar isn’t controlled.”
Having gestational diabetes also increases your risk of having it again during future pregnancies.
Who is at risk?
Asterino-McGeean says anyone can develop gestational diabetes during pregnancy, but these factors increase your risk:
Age (older than 25).
Family history of gestational diabetes.
Heart disease or high blood pressure.
Inactivity.
Obesity.
Having polycystic ovary syndrome (PCOS).
Previously birthing a baby that weighed nine pounds or more.
Presence of gestational diabetes in past pregnancies.
Race (being Asian American, Native American, Black or Hispanic).
How to manage gestational diabetes with a healthy diet
Consider a gestational diabetes diet plan your secret weapon to help prevent pregnancy and delivery complications. Even if you need diabetes medication, Asterino-McGeean says it’s still vital to follow a gestational diabetes diet.
“Help keep blood sugar levels in check with a well-balanced diet. It should include lean sources of protein, plenty of non-starchy vegetables and correctly portioned complex carbohydrates," she says.
Bissell notes that working with a dietitian can take the guesswork out of eating with gestational diabetes. “Your dietitian can help you set up balanced meals with the right amount of carbs to keep your blood sugars within the range your doctor recommends.”
Gestational diabetes food list
Here’s a list of the best foods to eat on a gestational diabetes diet:
Lean proteins
“These foods help you to feel full and are essential building blocks for your baby’s growth,” says Bissell. These include:
Chicken.
Eggs.
Fish.
Low-fat dairy.
Turkey.
“It’s especially important to eat proteins at breakfast for more stable hunger levels throughout the day. Proteins can even help lessen morning sickness.”
Non-starchy vegetables
These provide important vitamins, minerals and fibre, and you can consider them ‘freebie’ foods as they are very low in carbs,” Bissell says. These include:
Broccoli.
Cucumbers.
Green beans.
Onions.
Peppers.
Salad greens.
Healthy fats
Healthy fats help you feel full and are beneficial for heart health. They include:
Avocado.
Nuts.
Olive oil.
Seeds.
Nut butters (almond, peanut, cashew, etc.).
Complex carbohydrates
We need carbs for energy, fibre and certain nutrients. Complex carbohydrates include:
Beans.
Berries.
Brown rice.
Greek yogurt.
Sweet potatoes.
Whole-wheat bread.
Foods to avoid if you have gestational diabetes
If you are eating a gestational diabetes diet, avoid these foods:
Sugary beverages.
Simple carbohydrates such as breakfast cereals and processed foods or snacks.
Five tips to start eating better with gestational diabetes
Bissell recommends trying these five tips to get on the road to eating healthier:
Plan ahead: Think about your upcoming week and jot down a simple meal plan and grocery list to prevent last-minute food decisions because they usually result in less healthy choices.
Chop, chop: Pre-portion or chop up fruits and vegetables when you get home from the store to make them easier to grab when you need a snack.
Buy frozen: Stock your freezer with frozen vegetables. Even if the fresh veggies you picked out for the week go bad, you always have options.
Drink up: Carry a water bottle with you (and drink it throughout the day) to stay hydrated.
Balance your meals: Eat protein and vegetables with each meal and snack. Aim for three meals a day with snacks in between as needed.
Other ways to keep you and your baby healthy with gestational diabetes
Asterino-McGeean recommends keeping your doctor in the know as your pregnancy progresses. “Continue with your scheduled appointments. Since your pregnancy is considered high risk if you have gestational diabetes, your obstetrician may also have you see a high-risk specialist for the remainder of your pregnancy,” she says.
Managing gestational diabetes is ultimately a team sport — and you are the quarterback. “Self-monitoring blood glucose levels at home is important for a healthy pregnancy and baby,” adds Asterino-McGeean.
Here’s how to do it:
Monitor your sugar four times a day. After fasting (or when you wake up before breakfast) and one to two hours after each meal.
Keep a written log of your blood sugar levels. Send it to your doctor every one to two weeks or as they recommend.
“The most important thing is preventing high blood sugar levels to keep you and your baby safe,” says Asterino-McGeean.
Members of the T2D Healthline community share what it was like getting a COVID-19 vaccine
Aleksandr Zubkov/Getty Images
If you live with a chronic condition like type 2 diabetes, it’s likely that you have questions about COVID-19 vaccines and how they may affect you.
Some people with type 2 diabetes worry that the vaccine will cause a spike in blood sugar levels. Others have concerns about the potential side effects.
However, it’s important to remember that if you live with a condition like type 2 diabetes, you may also be at a higher risk of developing severe COVID-19 complications.
The overwhelming consensus among doctors is that the COVID-19 vaccine is the best way to protect yourself from COVID-19.
According to the Centres for Disease Control and Prevention (CDC), getting a COVID-19 vaccine is recommended and safe for most people living with chronic conditions.
If you have specific questions about how the vaccine may affect you or interact with other drugs you are taking, it is a great idea to speak with your doctor.
If your doctor has already suggested that you get the vaccine but you’re still feeling unsure, it can help to hear from others who know how you are feeling firsthand.
The T2d Healthline community understands what you are going through and is here to help. Here’s what seven members had to say about their experiences getting the COVID-19 vaccine.
“I got the Johnson and Johnson vaccine, one and done. So far, not one side effect. My blood sugar was lower afterward, but that may also be a result of fasting beforehand.” — Anjanette Brown
“I had absolutely no problems with anything except that it raised my blood sugar by about 20 points, but it is back to normal today. I had no fever, pain, or other typical side effects. My arm was a tiny bit sore. Nothing bad. I slept like a baby last night though! Best sleep I’ve had in ages!” — Sherry
“I got my COVID-19 vaccine! I have had some arm, knee, and foot pain but nothing bad. I felt tired after getting my first shot.
“The only thing that happened after my second shot was a sore arm for a few days then that was gone! There were no other side effects from the second shot. For me, getting the Pfizer vaccine was a very good experience.” — Debbie A.
Navigating the COVID-19 pandemic has been stressful and challenging for everyone. For people living with a chronic condition, and those with loved ones living with chronic conditions, this stress and anxiety has been magnified.
Deciding to get a COVID-19 vaccine may feel like a big deal, but it doesn’t need to feel scary. The COVID-19 vaccines currently available have been granted emergency use authorization by the FDA.
Doctors agree that the vaccines are safe and effective and that their benefits far outweigh the risk of side effects.
Getting vaccinated is the best thing we can do as individuals to protect ourselves, our loved ones, and our communities.
A new diagnosis can be overwhelming, but you’re not alone. The T2D Healthline community is here to help
As of 2020, the Centres for Disease Control and Prevention (CDC) estimates that more than 10 percent of Americans live with diabetes and nearly a third of all American adults have pre-diabetes.
Type 2 diabetes is far more common than type 1 diabetes, and it accounts for nearly 90 percent of all global diabetes cases.
While type 2 diabetes cannot be cured, it can be managed through diet and lifestyle changes. However, for many, receiving a type 2 diabetes diagnosis may be the first time they’ve had to face significant health changes. This prospect can feel daunting.
Even though type 2 diabetes is very common, a new diagnosis may make you feel alone.
It can feel isolating, as though your friends and family members just don’t understand what you’re going through. It’s important to remember that you’re not alone.
The T2D Healthline community is filled with people who truly understand what you’re going through, because they’ve been there themselves.
Five community members shared their words of wisdom for people navigating a new type 2 diabetes diagnosis
“As we say in the South, ‘It ain’t nothing but a chicken wing.’ You can get out in front of this. It’s shocking at first. Once you make lifestyle changes, and they become routine, then it becomes second nature.
You may be fine for many years, and some people even go into remission. Just think about the millions who are unaware or don’t care. You’re that much further ahead of millions. Now it’s time to get busy living.“ – Robert Ward
“It definitely can be overwhelming. Just stop and take a big deep breath.
It’s going to be OK. It’ll require some work on your part, but nothing you can’t handle. I would first recommend seeing a dietitian to help you figure out what you should be eating.
In the meantime, work on eating healthy low-carb meals and snacks. Try to get some exercise and drink plenty of water. There’s definitely a lot of information available on the T2D Healthline app, and you can ask questions. The people here are always here to help. Take it one day at a time.” – Brian D.
“I was overwhelmed at first. I definitely had anxiety about the diagnosis (in addition to other things). A nurse practitioner suggested I see a psychiatrist, which I never would have thought to do.
You have to try to look for positives. It can help to see all the success stories on the T2D Healthline community from people who struggled at first and have made truly incredible progress.
Some calming tricks can help, too. Whether it’s some kind of meditation, relaxation, or essential oils, they can help you through the adjustment and minimize the stress of it.” – Chris
“I’m 3 months in and have made a lot of changes to my diet.
Don’t worry. After a few weeks of making changes, you’ll start getting used to it and not feel like the new diet is such a big change. Adding lots of veggies can help you stay full.
Think creatively of different ways to add them in: roasted, steamed, raw, soup, and more!” – Cherie Jordan
Facing a new type 2 diabetes diagnosis may feel challenging, but it’s a challenge you can handle.
With time, you’ll find new routines that work for you, and you’ll start to feel more confident in your ability to manage your health.
Especially at the beginning, it may feel like you have a lot to learn, and you probably have many questions. The T2D Healthline community is here for guidance and support every step of the way.
Adults with type 1 diabetes should take several key steps to optimize recovery after exercise, such as adjusting insulin dosing and protein and carbohydrate intake, and carefully monitoring blood glucose, according to a consensus statement.
The statement, developed by the working group for the study of integrative biology of exercise in diabetes and published in The Lancet Diabetes & Endocrinology, also highlights strategies for caffeine intake, cool-down routines based on glucose level and how to help ensure proper sleep. The working group noted that the recovery routine after exercise for adults with type 1 diabetes has received little attention in scientific literature, with most of the focus placed on insulin or nutritional adaptations to manage glycaemia before and during the exercise bout.
Source: Adobe Stock
“The post-exercise recovery period presents an opportunity for maximizing training adaption and recovery, and the clinical management of glycaemia through the rest of the day and overnight,” Sam N. Scott, PhD, a research fellow at the University of Bern in Switzerland and head of research for Team Novo Nordisk Pro Cycling, and colleagues wrote. “The absence of clear guidance for the post-exercise period means that people with type 1 diabetes should either develop their own recovery strategies on the basis of individual trial and error or adhere to guidelines that have been developed for people without diabetes.”
Unique concerns when exercising
For athletes with type 1 diabetes, the challenge of managing glycaemia makes recovery after exercise more difficult, the researchers wrote. These athletes must also consider the effects of altered insulin sensitivity, hyperglycaemia after exercise, depleted glycogen stores, dehydration, impaired glucose counter-regulatory responses, insulin doses, abrupt changes in the rate of muscle glucose uptake due to a halt in muscle contraction, and the effect of nutritional selection on blood glucose concentration.
“The quantity of post-exercise carbohydrate intake will depend on the type, duration and intensity of the exercise done, as well as blood glucose concentration and the circulating amount of insulin,” the researchers wrote. “If maximizing the rate of muscle glycogen resynthesis is the primary aim (which is common for endurance or ultra-endurance athletes that compete multiple times within a short time span), post-exercise carbohydrate ingestion is the most important factor establishing the rate of muscle glycogen synthesis.”
The authors make several recommendations to optimize recovery after exercise in type 1 diabetes:
Check glucose immediately after exercise and at regular, 15-minute intervals; be alert for hyperglycaemia or hypoglycaemia.
Insulin adjustments can vary depending on circumstances; however, consider reducing insulin dose before exercise and reduce the first basal dose during the recovery period, particularly if the exercise session lasted 30 to 60 minutes. Reduce bolus insulin dose with recovery meal.
Initiate carbohydrates when glucose is less than 144 mg/dL, particularly if glucose is decreasing.
When rapid recovery from a long period of exercise is the objective and peak performance is required within 24 hours, aim to consume 1 g to 1.3 g of carbohydrates per kilogram per hour for the first 4 hours of recovery, starting as soon as possible after exercise, with frequent feeding intervals thereafter — every 30 minutes.
Daily protein recommendations are 1.6 to 1.8 g per kg per day for endurance athletes. Protein added to carbohydrate immediately after exercise might speed up recovery.
Be aware of the effects of drinks containing high amounts of carbohydrate on blood glucose concentration. Hydrate with carbohydrate-free drinks if blood glucose concentration is greater than 180 mg/dL.
Be aware of hot or humid conditions.
Approximately 200 mg to 300 mg of caffeine might reduce the risk for hypoglycaemia during and after exercise; this can be consumed alongside glucose.
Avoid high amounts of caffeine consumption late in the day, which can negatively affect sleep.
If blood glucose is greater than 180 mg/dL during the last 10 minutes of exercise, consider a more prolonged, low-intensity cool down. If during the last 10 minutes of exercise the blood glucose concentration is between 90 mg/dL and 180 mg/dL, reduce the length of the cool down.
‘Greater planning’ needed
Researchers noted that rapid developments in technologies, such as continuous glucose monitoring sensors, smart devices or wearables, and closed-loop insulin delivery systems, all contribute to the possibility of an increased time in range around exercise with less input from the user. Hybrid closed-loop systems offer benefits for improved time in the glycaemic target range overnight, even under demanding environmental and unplanned conditions, they wrote, and future advances in machine learning will likely increase decision support.
“Regardless of the athlete’s sport or competition level, it is clear that many different behaviours will have an effect on short-term and long-term recovery, and thus affect the subsequent performance, training adaptation and time in the target glycaemic range,” the researchers wrote. “Athletes with type 1 diabetes should always prioritize blood glucose management, which is essential for overall health and to optimize aspects of recovery. However, the unique ability of people living with type 1 diabetes to influence their insulin concentration through exogenous administration suggests that greater planning and attention is needed to optimize nutrition and insulin strategies for glycogen resynthesis.”
A dental intervention among patients with type 2 diabetes improved their oral health-related quality of life, a pilot study in the Netherlands showed.
Periodontitis is a complication of diabetes mellitus, according to researchers. In addition, patients with diabetes appear to have a higher prevalence of other oral conditions such as dry mouth, Candida infections, taste disorders and oral malignancies.
“Clinical, fundamental and epidemiological research into the connection between diabetes and oral health has been accumulating over several decades,” Martijn J. L. Verhulst, a PhD candidate in the department of periodontology at the University of Amsterdam and Vrije Universiteit in the Netherlands, told Healio Primary Care. “We believed now was the time to investigate how clinicians in primary care could use that knowledge on a daily basis, in a way that actually benefits patients.”
Martijn Verhulst
Verhulst recruited 24 family medicine practices and randomly assigned them in a 1:1 ratio to be part of an experimental cohort or a control cohort. The practices chose which patients with type 2 diabetes would participate in the study. Those in the experimental cohort received:
repeated messages about the importance of good oral health and the need to brush twice daily with a soft toothbrush and a fluoride toothpaste;
frequent encouragement to visit a dentist and, since oral care is not covered under the Netherlands’ mandatory basic health care insurance, the paperwork that would be required to see a dentist twice annually; and
The family practitioners in the control cohort did not provide any “extra attention to oral health” for their patients with diabetes, Verhulst and colleagues wrote in Annals of Family Medicine.
The researchers reported that among the 764 patients in the study, 543 completed most of the 14-item Oral Health Impact Profile — a survey that measures frequency of functional limitations, physical pain, psychologic difficulties, handicaps and physical, psychologic and social disabilities — at baseline and 1 year later.
More patients in the experimental cohort said their oral health improved compared with the control cohort (35.2% vs. 25.9%; P = .046). A secondary post hoc analysis that included the 18 family medicine practices where 60% or more of the patients completed the Oral Health Impact Profile also favoured the experimental cohort (38.3% vs. 24.9%, P = .011). There was no significant improvement in the number of self-reported oral health complaints among the cohorts, and the researchers said that the experiment had a minimal effect on the general health of its participants.
Verhulst encouraged physicians to find time to discuss oral health with their patients.
“In a number of cases, this will result in the identification of previously undiagnosed periodontitis, which can then be treated appropriately,” he said in the interview. “Beyond this potential benefit, the impact poor oral health has on quality of life, social life, speech, self-confidence, chewing, pain, loss of productivity, etc., should be reason enough to strive for an interdisciplinary approach.”
Lisa Simon, MD, DMD
In many ways, this study proves what we already know about lots of other health outcomes and behaviours: motivational interviewing and longitudinal support from a primary care team helps empower patients. It is high time these principles were also applied to oral health.
This study leverages the team‐based care and trusting primary care relationships patients already had to help them achieve better oral health, something all of us who work in primary care should aspire to. I also think it is wonderful that this study focused on oral health‐related quality of life — a patient‐centred outcome.
While there is a developing evidence base that suggests oral health may affect diabetes outcomes, what is far more important is that oral health causes unnecessary suffering for far too many people. Independent of quantitative clinical outcomes, allowing people to live happier lives is an outcome worth celebrating.
Lisa Simon, MD, DMD
Fellow, oral health and medicine integration, Harvard School of Dental Medicine
Type 1 diabetes, once called juvenile diabetes, is a chronic disease that can appear in children of any age. It can be difficult to notice the signs of type 1 diabetes in toddlers because they can’t clearly communicate to you that they are feeling ill.
Type 1 diabetes is an autoimmune disease that destroys the cells of the pancreas so that it produces little or no insulin. Insulin is a hormone that lowers blood sugar (or blood glucose) by transporting sugar molecules from the blood into cells to be used for energy. When the pancreas cannot produce and release enough insulin, blood sugar remains chronically elevated, causing a variety of problems.
To minimize the risk of diabetes and get help for your toddler as soon as symptoms appear, watch for these warning signs associated with changes in blood sugar.
Frequent Urination
When there are high levels of sugar in the blood, the kidneys try to restore balance by excreting excess sugar in the urine. Excess sugar in the urine, known as glucosuria, produces a diuretic effect that causes the body to pass large amounts of water, resulting in the need to urinate more frequently.
For children who wear diapers, this can result in more soaked diapers and the need for repeated diaper changes. For children who are potty-trained, it can cause frequent accidents, and bed-wetting.
Ongoing Extreme Thirst
Because children with type 1 diabetes have an increased urge to urinate, the excessive loss of water leads to a fluid imbalance and dehydration. As a result, despite drinking large amounts of water or other fluids, children with type 1 diabetes will have an extreme thirst that is difficult to quench.
Increased Appetite with Weight Loss
The body relies on insulin to transport sugar into cells to use for energy. Without sufficient levels of insulin, which occurs in type 1 diabetes, the body's tissues become starved of the energy they need to function properly. Because of this, increased appetite and extreme hunger can result, as well as weight loss from improper nourishment.
While young children may not be able to verbalize that they are hungry, they may express their hunger in other ways, such as increased irritability, crying, and whining. Children may also eat average or larger-than-average portions of food but lose weight instead of gaining it as they grow.
Extreme Fatigue
Because the cells of the body are not being supplied with adequate sugar for energy, children can experience extreme fatigue. Signs of extreme fatigue in young children include increased sleeping, drowsiness, and lethargy, or lack of energy.
Sudden Vision Changes
Vision changes can occur with type 1 diabetes because the presence of excess sugar in the blood contributes to damage to blood vessels, including those that supply blood to the retina of the eye. This can result in blurriness and loss of vision.
While young children may not be able to say that they cannot see well or that things appear blurry, they may compensate by bringing objects much closer than necessary to their faces, sitting close to the television, or not responding to people or movement at a distance.
Yeast Infections
Type 1 diabetes increases the risk of genital yeast infections since increased blood sugar creates an ideal environment for the Candida fungus to grow in moist areas of the body. Urinating more frequently and wearing a wet diaper for a long period of time also put children at risk for diaper rash caused by yeast infections from type 1 diabetes.
Fruity Breath
Because their bodies cannot effectively use sugar for energy due to insufficient levels of insulin, children with type 1 diabetes have to instead burn fat for energy. When fats are broken down, by-products called ketones are produced. Ketones accumulate in the blood and are used as an alternate energy source.
Ketones interfere with the body’s pH balance (the balance of acidity and alkalinity) and can result in metabolic acidosis. Acetone is one of the primary ketones produced inmetabolic acidosis. It is expelled from the body through the breath and gives off a fruity odour.
Unusual Behaviour
The development of metabolic acidosis and disrupted pH balance in the body can cause unusual behaviour. Children may be disoriented and lethargic or display increased irritability, moodiness, restlessness, crying, and temper tantrums.
Poor Wound Healing
The transportation of amino acids, which are the building blocks of proteins, into cells requires insulin. Protein is made in cells. Since people with type 1 diabetes don't have enough insulin, they have increased protein breakdown.
Breakdown of the body’s proteins decreases the body’s ability to heal and repair damaged cells. Because of this, children with type 1 diabetes have a delayed rate of healing, may be more susceptible to bruising, and may take longer to recover from rashes and skin irritations.
Impaired immune system function and poor circulation due to nerve and blood vessel damage may also contribute to poor wound healing.
Breathing Problems
Metabolic acidosis disrupts the body’s natural pH balance because ketones can make the blood acidic (a lower pH). To restore pH to a normal level, the body compensates by increasing the rate of breathing. This helps raise the pH level of the blood by increasing oxygen levels while reducing carbon dioxide levels. Laboured breathing and rapid, shallow breaths result.
Summary
If your child has been showing unusual signs such as weight loss, fatigue, increased thirst and hunger, and an increased urge to urinate, they may be experiencing type 1 diabetes. Fruity breath and delayed wound healing are hallmark signs of type 1 diabetes and require immediate medical attention.
A Word From Verywell
Identifying the signs of type 1 diabetes in toddlers can be difficult because little ones can’t clearly tell you that they’re feeling ill. Knowing what to watch out for can help you determine the need to speak to your paediatrician about your child’s symptoms and the possibility of type 1 diabetes.
Diabetes is a very common condition that affects about five million people in the UK. Making small changes to your diet plan could have a huge impact on your chances of developing high blood sugar.
Type 2 diabetes is caused by the body not producing enough of the hormone insulin, or the body not reacting to insulin.
About 90 percent of all diabetes patients have type 2 diabetes, which can usually be managed with lifestyle changes.
It can be quite difficult to know if you have diabetes, because the symptoms can go unnoticed for long periods of time. In fact, huge numbers of people have their diabetes diagnosed after a routine health check at their doctor’s surgery.
“Mediterranean diets rich in fruit and vegetables are known to be healthy for people with diabetes,” it said.
“As well as being protective against type 2 diabetes, Mediterranean diets rich in fruit, vegetables and fibre can help people with diabetes to control their blood sugar levels. One of the reasons why Mediterranean diets are healthy is that they include a strong vegetable content. Vegetables such as tomatoes, peppers, aubergines, olives, onions, rocket and lettuce are not only great for blood glucose levels but make for very visually appealing meals too.”
A Mediterranean diet is generally comprised of oily fish, poultry, fresh fruit and vegetables, legumes, fresh bread, pasta, and olive oil.
Most people should be able to add a moderate amount of fruit to the diet plan.
Lower carb fruits, including berries, are best for patients that are liable to blood sugar spikes. Combining your Mediterranean diet with regular exercise has been linked to a much lower risk of developing type 2 diabetes.
Large numbers of people may be at risk of diabetes without even knowing it. The symptoms don’t necessarily make you feel unwell, so it’s often diagnosed at much later dates. The most common signs of type 2 diabetes include feeling very tired, unexplained weight loss, passing more urine than normal, and feeling very thirsty.
Speak to a doctor if you’re worried about the warning signs of diabetes.
I’ve lived with type 1 diabetes (T1D) for 49 years, and this past year the ground feels a bit shakier under my feet. I have discovered a second truth about living with diabetes.
The first was the one I wrote about 4 years ago on the HuffPost: “My whole life, all day, all night, every day, and each night is about keeping my blood sugar between the red and yellow lines [on my continuous glucose monitor].”
My new truth is: No matter how hard you work at this, no matter how well you manage your blood sugar, take your insulin, even correction doses, keep your supplies stocked, keep up with your doctor visits, you may still, just because of time, experience not necessarily major complications of diabetes, but enough minor complications to make you want to throw yourself under a bus, or out the window, or just feel really sad. That said, please don’t. I do know that the sun will shine again.
Since COVID-19 has now brought “long-haulers” into the lexicon, I suppose this is a long-hauler’s report of where I am right now, here on the eve of my Joslin Diabetes 50-year medal.
About 8 months ago, I began to have a succession of diabetes ailments, even though over the past two decades I’ve managed my diabetes extremely well, over the past several years brilliantly.
These ailments have worn at me physically and emotionally, and maybe even more injurious, they have upended my sense of myself. They remind me that no matter how well things are going, no matter how well I was doing, I really do have a chronic, progressive illness.
I felt compelled to write this as a way to right me, and to add to the scant literature on what it’s like to live with type 1 diabetes for decades.
As you read this, however, know that if you are earlier in your journey with diabetes than me, you have, and will continue to, benefit from the technology and information I didn’t have, and the more that is coming.
Or if you have lived with T1D a long time like me, maybe it’s nice to hear someone confirm what you’ve experienced.
We who live with T1D all learn pretty quickly: It’s not about the shots. It is about the 180 decisions per day medical journals say we make to manage our blood sugar. It is about how this daily decision-making puts our nervous systems into constant hypervigilance.
It is about fearing the major complications I was told in my hospital bed at age 18 that would befall me: heart attack, kidney disease, amputation, blindness. Scared silly for weeks afterward, I went to sleep opening and closing my eyes, testing what the world would be like if I could no longer see it. Need I tell you I was an art major?
It’s almost ironic, when we talk about a chronic illness, that we rarely talk about the even keel times and how complacent one becomes when things are going well. That’s exactly why, when a few sharp jabs came along, I was thrown and experienced unexpected, profound grief.
The underbelly of T1D, in the words of poet Carl Sandburg, creeps in on “little cat feet” — quietly, surreptitiously. One day you awake from your complacency noticing a little new health insult and your mind whirls, ‘How can this be happening?’, ‘What will yet come to steal my joy, equanimity, health?’
There’s no getting around the fact that people who live with T1D over time experience certain disorders at higher rates than the average population.
When my thumb began popping 3 months ago, I posted on Facebook about it, asking who had also experienced trigger thumb? It garnered a small tsunami of replies: Dozens of peers who have lived with T1D dozens of years shared about their trigger fingers. And their Dupuytren’s contractures. And their stiff hand syndromes.
Had I asked for other conditions accumulated over the years, I would have heard about their Charcot osteoarthropathy, their retinopathy and neuropathy, their diabetic amyotrophy and their fibromyalgia.
People who live with T1D over time experience muscle, musculoskeletal and joint disorders at increased rates compared to the general population.
But it was not the pain of my trigger thumb alone, while annoying and uncomfortable, that caused my house of cards to collapse. Out of the blue, I developed psoriasis, a third auto immune condition behind my T1D and Hashimoto’s disease.
Then came a mysterious itch in the centre of my back that seems to be nerve-related. Then howl-worthy, frequent cramping in my feet. Even turning in bed or stretching in the morning set off a cramp. This was accompanied by tingling in both calves that I have experienced on and off since I was diagnosed at 18. Now, however, there appeared to be no off. The nerves in my calves are vibrating as I write this.
I no longer experience myself as the dutiful patient, who, working hard at keeping my blood sugar in range, has already experienced all the complications I’m going to get — two frozen shoulders 15 years apart, occasional tingling in my calves, and hearing loss.
My recent heartbreak — you may think I’m crazy — is actually the loss of a certain carefreeness. The expectation that if I do good, I’ll get good.
Now I have been reminded, as each complication reminds us, that I am vulnerable to a multitude of breakdowns, each one taking a small, but life changing, bite out of me. The knowing, that likely more insults will come no matter what I do, scares me.
A month ago, standing in my kitchen, it crossed my mind that were I to fill out that form you do in the doctor’s office asking how your general health is, I would have ticked “good” as I always do. Yet, were I to fill it out honestly today, I would have to tick “poor” or “fair.”
I should mention, I am aware that the stress of living through a pandemic has likely contributed to my current state of health. I do not blame diabetes for all of it — still, there it is.
When we were engaged, I told my husband-to-be, “You can back out of this marriage and I won’t hold it against you. I cannot guarantee what life will be like living with someone who has type 1 diabetes.” Now, 20 years into our marriage, it’s becoming true.
Anyone who knows me, or the man who refused to listen to my tearful argument and married me anyway, knows that no matter what comes, he will never regret his decision. Lucky me, but I am sad that these past several months I keep telling him something else that is wrong with my body.
I see my job as a chronicler. I am ahead, in years, of many of my friends and peers with this disease, and not all of us will arrive at this destination.
And here’s a just as important part of the story: With treatment, my trigger thumb went away, as did my psoriasis, and mystery itch. The leg cramps and tingling have once again lessened, and I have no idea why. But I’ve also made an appointment with a neurologist to see what more I can learn or do.
When I interviewed people early in my diabetes work, many young people said they appreciated that getting T1D made them more mature and compassionate. Maybe weathering decades with diabetes’ ups and downs has made me more resilient. That’s a good thing.
And still, I am an optimist. I am bouncing back as things begin to improve.
All told, I believe that being on blood sugar patrol 24/7 deserves more respect from health professionals and more doses of compassion from and for ourselves. And I believe we should be speaking into this void of what it’s like to live a long time with type 1 diabetes; children grow up.
That said, it is not lost on me that many of us are here to share what it’s like to live a ‘long life with diabetes.’ And that is very much in the plus column.
Since I do believe diabetes has made me more resilient, here’s how I stay, and get, myself righted when things are tough.
I seek medical attention as needed and, like a dog with a bone, I keep going til I have the best answer or treatment.
I do deep research online for whatever I’m trying to solve; information calms my waters.
I share my feelings with my husband and friends whom I know are supportive and will understand.
I look at what I have — health, friends, loved ones, comfort, pleasures like eating a good meal — and I am grateful.
I go back to the tried and true things that work for me in my everyday diabetes management: routine, low carb eating, daily walks.
I have a spiritual practice of qigong and meditation. Keeping them up when all feels shaky is the key.
I burrow into pure escapist entertainment like a multi-season Scandinavian crime noir series on Netflix and only come up to eat and go to the bathroom. Sometimes not even that.
I remind myself that dark clouds come and they go, and I do not know the future. So, I envision one that pleases me where my issues are resolved or manageable.
Riva Greenberg is a health researcher, health coach, diabetes author and activist. Her work is dedicated to helping people with diabetes and health professionals work collaboratively in a way that helps both flourish. She has written three books and blogs at DiabetesStories.
When adults see their doctors for tests and learn they may have chronic kidney disease, it is often a time of fear, with visions of dialysis or transplant surgeries jumping to life in the imagination.
Chronic kidney disease is scary. The kidneys play so many roles – filtering waste from our blood, regulating fluid levels and releasing hormones – and their function is related to high blood pressure and diabetes.
“When we show patients the two conditions are related, they tend to understand the path forward,” said Robert Allison, MD, Avera Medical Group Internal Medicine. “We use blood and urine testing to determine the level of kidney function. We then consider the different options for treating their blood pressure or diabetes so we can help prevent chronic kidney disease from going further.”
Lifestyle, Medication and Kidney Disease
Chronic kidney disease has five stages. When patients progress through the stages, treatment may include medication. It often includes, coaching, too.
“Prevention is our goal, especially when people have tough blood-pressure situations, where they might be taking several medications,” said Allison. “If diabetes is also a factor, then the management can become more complicated.”
Our kidneys release hormones that affect many other organs, including the heart. The regulation of blood pressure is part of their work. Since they’re also cleaning our blood, when blood sugar (glucose) levels are too high, which happens with diabetes, they’re under stress.
“Chronic kidney disease is, in many ways, a math problem,” Allison said. “Figuring out the equation is the hard part – how to keep the kidneys functioning by controlling the blood pressure, as well as reducing glucose levels in our diabetic patients. Our goals are to ensure that the blood pressure and/or diabetes are well managed, that way the kidney can do its work. That’s why annual exams are important for adults, be they 18 or 108 years old. We can find the problem during that visit.”
Weight loss, sensible diets and exercise, not smoking and tracking blood pressure all can help prevent the triad or lessen their impact.
“Lifestyle changes, even losing as little as 10 pounds, can help make the chronic kidney problems easier for both me and my patients,” he said.
Management of Conditions Can Change Everything
Seeing a doctor regularly can help anyone who might face problems with blood pressure and new kidney problems and catch them in time to get on the right track.
“I see patients every day who have success making lifestyle choices. Too often we think of significant lifestyle changes as impossible – that’s a myth,” said Allison. “If you want to be there for your kids and grandchildren, you’ll have to work at it.”
A coordinated care team supports patients.
“Internal medicine is a specialization, like nephrology, and when patients need specialists, we are there to work with them, ready to help them as they work with us to solve the problems that can come with blood pressure, diabetes and kidney issues,” he said. “We see people who go from that initial fear of their condition to living long lives that avoid diabetic amputation, dialysis and kidney transplants. These are serious conditions – but together we can manage them.”
Diabetes is a chronic disease that affects many older adults andis a significant health issue for the United States. Diabetes is expected to be the seventh leading cause of death worldwide by 2030, according to the World Health Organization. The U.S. Centres for Disease Control and Prevention says more than 34 million Americans have diabetes, and 26.8% of those were at least 65 years old. These numbers are expected to continue rising exponentially as the aging population increases.
But what is pre-diabetes?
Pre-diabetes is a condition that demonstrates an increased risk for diabetes. It is identified when a person has a higher than normal blood sugar level, but not consistently high enough to be considered diabetes. With pre-diabetes, the body develops resistance to its own insulin. It’s important to take pre-diabetes seriously, as this condition can lead to Type 2 diabetes, heart disease and stroke.
The American Diabetes Associationrecommends that once you turn 45, you begin regular pre-diabetes screenings and an annual assessment of the haemoglobin A1c. If tests are normal, then repeat testing may be conducted at three-year intervals.
The haemoglobin A1c test will reveal your average blood sugar levels for the past three months. This blood test may be used to diagnose pre-diabetes or diabetes. If your haemoglobin A1c is between 5.7% to 6.4%, for example, then you are within the range for pre-diabetes. If the haemoglobin A1c result is 6.5% or greater, then diabetes may be diagnosed.
Assessment for pre-diabetes may start at an earlier age or occur more frequently if you have multiple risk factors for diabetes. Common risk factors include an inactive lifestyle, being overweight or obese, having a history of gestational diabetes, or family history of diabetes. It’s important that pre-diabetes or diabetes does not go undiagnosed, so timely and focused communication with your doctor is essential.
What causes pre-diabetes and how can you prevent it?
While the exact cause of pre-diabetes is unknown, family history and genetics play an important role in its development. Some ethnicities have a higher risk of developing pre-diabetes and Type 2 diabetes over others. These include African American, Hispanic, Asian and Pacific Islander people.
While some risk factors are beyond your control, there are important lifestyle adjustments that may indefinitely hold off the onset of pre-diabetes.
Good nutrition: Naturally regulate your blood sugar by choosing healthy carbohydrate options such as whole grains, fruits and vegetables. Avoid foods that are high in processed sugar, saturated fats and trans fats. Consider connecting with a dietitian who can help you meal plan and provide you with meaningful options to inspire healthy nutrition decisions.
Exercise frequently: With age, you may experience muscle and joint discomfort, diminished vision, or loss of balance, which can interfere with your motivation to get more active. The ADA recommends 30 minutes of sustained aerobic activity most days of the week. Always check with your doctor before starting any new physical activity.
Know your numbers: It is essential to know the ADA-recommended goals and targets for blood sugar, blood pressure, cholesterol, fasting blood sugars and haemoglobin A1c. Be sure to ask your doctor for lab results at every visit. Adjusted blood sugar goals may be indicated for older adults with multiple chronic illnesses. Do not hesitate to ask questions and keep notes on how you’re doing with your health goals.
Pre-diabetes: the good news
Consistent healthy lifestyle choices can help prevent progression to pre-diabetes or diabetes. So start today. Initiate discussions about diabetes with your doctor, review your risk for developing pre-diabetes or diabetes and create a plan to make healthy adjustments to your nutrition and activity.
Finally, don’t overdo it. Start with one new healthy habit and live with it for a month, before adding a new habit to the routine. As always – have fun, nurture the support of friends and family, and make it an interesting journey.
Linda Kerr is the director of the Diabetes Program at MemorialCare Long Beach Medical Centre.
By Craig Idlebrook, fact checked by Jennifer Chesak
Living with any kind of chronic health condition is mentally taxing. You may have noticed that, thankfully, our healthcare system is paying increasing attention to the mental and psychosocial burdens these days — and the concept of resilience has become core.
But we bet you didn’t know that there’s a lab dedicated entirely to building up resiliency in people with diabetes (PWDs).
Yep, it’s called the Resilience and Diabetes (RAD) Behavioural Research Lab at Baylor College of Medicine in Houston, Texas, and it’s spearheaded by Marisa Hilliard, PhD, an associate professor of paediatrics and diabetes psychologist. Her work focuses on two major areas: psychological support for people with serious and chronic conditions, and positive psychology.
There are a number of “resilience labs” popping up around the country, for example at the University of Southern California (USC), at the University of California San Diego (UCSD), and at Wayne State University in Michigan.
But Hillard’s is the first to home in on life with diabetes.
“I thought, ‘Gosh, positive psychology seems to fit really well with all of these things that I’m interested in with kids with diabetes.’ So, I tried to bring that positive psychology perspective to understanding the challenges of living with a complex chronic problem like diabetes,” Hilliard told DiabetesMine.
Indeed, insulin-dependent diabetes is one of the few chronic conditions in which the patient (or their family) is responsible for an onslaught of daily adjustments that never seems to end. One Stanford University study found that people with type 1 diabetes (T1D) need to make at least 180 decisions a day related to blood sugar management. Inevitably, some of those decisions don’t pan out as planned, and that leaves plenty of room for frustration and self-doubt.
How can you not go a little crazy trying to manage all that alongside all the regular challenges that life serves us?
Diabetes blogger and T1D advocate Scott Johnson says that too often people with diabetes kick themselves when blood sugar swings happen, and over inevitable slip-ups in navigating this constant state of medical improvisation.
“I think we are too critical of ourselves, and don’t give ourselves enough credit,” Johnson said. “We may feel like we’re being ground down, but we’re actually showing much more resilience than we think.”
Over the years, diabetes-focused healthcare providers are increasingly understanding the importance of resilience. As average A1C results have risen despite advances in insulin and diabetes technology, many healthcare providers are realizing the value of supporting PWDs with the mental aspects of the condition.
Often, this discussion focuses on how best to support PWDs who may be facing mental health challenges of burnout, depression, or disordered eating. Over the years, however, a committed group of psychologists and healthcare professionals have instead advocated for helping PWDs recognize and draw on their resiliency. They contend that all people have important strengths to help them manage a chronic condition, and to keep them afloat when things go wrong. What’s important, they say, is to support those strengths.
Hilliard, a clinical paediatric psychologist and behavioural scientist, leads a core multidisciplinary research team that includes a psychology postdoctoral fellow, and five research coordinators. The coordinators include post-bachelors staff, graduate students in psychology, and a licensed clinical social worker. The group works closely with behavioural scientists, endocrinologists, and statisticians at Texas Children’s Hospital, Baylor College of Medicine, and other institutions.
Together, this team tests out clinical interventions intended to encourage and foster resilience in paediatric patients. Their research projects include a range of study methods — surveys, qualitative interviews, and behavioural intervention techniques — to see what works, and what doesn’t. It’s all in the quest to relieve diabetes distress and build up resiliency among children and teens with T1D, and the families who support them.
Currently, the lab is working on the following projects:
DiaBetter Together is testing a strengths-based peer mentor intervention for young adults with T1D as they are transitioning between paediatric and adult healthcare settings.
PRISM-Diabetes is a multi-site trial, led by Dr. Joyce Yi-Frazier at Seattle Children’s, testing a resilience-promotion program for teens with T1D who are experiencing diabetes distress.
The lab also recently completed the First STEPS study, a multi-site trial led by Dr. Randi Streisand at Children’s National Hospital, testing a stepped-care intervention for parents of young children newly diagnosed with T1D.
Typically, the lab recruits study participants through the diabetes clinics at Texas Children’s Hospital, the largest children’s hospital system in the United States, but sometimes the lab has broader recruitment and can offer opportunities to participate for people who are not seen at Texas Children’s. In those cases, they often share recruitment opportunities through local or national diabetes family groups, social media, or other word of mouth methods.
DiabetesMine asked Hilliard about how resilience fits into diabetes care, and specifically how her lab helps healthcare providers encourage resilience in PWDs and their families.
First off, how do you define resilience when it comes to living with diabetes?
There’s a lot of debate over whether resilience is a trait, a process, or an outcome. Where I land on it is that to be resilient means that you are doing well in some area in your life, and managing the challenges of living with diabetes.
That can mean you are doing well with your glycaemic outcomes. That can mean you are doing well by avoiding hospitalizations. That can mean you have a good quality of life. It can be that you’re doing all the things outside of diabetes — learning to drive a car, managing friends and school — and making diabetes work along the way.
To me, resilience is about… living well with this condition and all of the challenges that it brings.
So, resilience is not about mastering everything in your life?
A lot of people would agree that you don’t have to be resilient in every single area of your life, and it would be hard to find anyone who is doing well in every single area of their life. It’s about doing well in some areas, and figuring out the challenges in others.
For example, you might be doing really well socially and in school, and doing really well with checking your blood sugars, but, gosh, those A1Cs are still high because you’re 14 and your hormones are going nuts. And that’s OK.
That’s why I don’t think of resilience as a personal trait, a thing that you have or don’t have. I think of it as how you’re doing in particular areas of your life.
Can you give an example of how you guide healthcare providers to foster resilience in patients with diabetes?
We had teens and parents answer some questions about diabetes management and diabetes strengths, and then we gave a summary of the answers to those questions to the teen, the parent, and the provider. We taught the provider to start the diabetes care visit with a discussion of those strengths.
The conversation often went like this: “Let’s talk about your strengths. Wow, last time you were here you said you never wanted to tell anyone about your diabetes, and now you said that you almost always talk to your friends about diabetes. That is amazing, you’ve made so much growth! How have you done it? Let’s talk about that for a few minutes.”
Starting the conversation with some recognition of what the person with diabetes is doing well can really set the tone for the whole conversation. So, my advice is to remember that the people you’re talking to have an emotional reaction to the words you’re saying and the information you’re giving them. Remind them what they’re doing well, and keep focusing on “How do we get you where you want to go?” as opposed to “What did you do wrong?”
How can people with diabetes build up resilience?
First, think about what it is that you’re good at, and what it is that you like doing. These don’t have to be specific to diabetes. For example, it could be someone who likes spending time with friends, or a child who is very artistic.
For the person who is connected with their friends, how can you use your social skills and your social interests to help you with diabetes management? Maybe you find a friend who’s gonna be your diabetes buddy, and check in with you. For a child who is artistic, maybe they make a colourful chart with cool pictures of all their daily tasks, and they get to decorate it and make it a fun activity to track their daily diabetes management tasks.
It’s about taking a thing they like, and applying it to a mundane, boring, or frustrating part of living with diabetes.
What would you say to parents of a newly diagnosed child who might be sceptical about trying to focus on resilience when they’re still trying to get the hang of blood sugar management?
The first thing I would say is, “You don’t have to.” Every family can choose what’s most important to them. Maybe right now for a family, what’s most important to them and their biggest priority is figuring out hypoglycaemia, or figuring out how to get their kid on the insulin pump that they want. And that’s fine.
But I think it’s important for people to at least be aware of these issues, because life with diabetes is not just glycaemic control and glycaemic outcomes. It’s all the parts of everyday life that you might not see in glucose tracking.
In an essay Johnson recently wrote about Hilliard’s work, he noted how essential resilience is to PWDs because it helps people like him navigate the many small and large pitfalls of blood sugar management.
He also says that people with diabetes might have a head start on building resilience.
“There’s no way to build that resilience muscle without going through challenging situations. Just by the simple experience of having the doctor say ‘You have diabetes,’ is in and of itself is challenging enough to qualify,” Johnson said in a later interview.
Jill Weissberg-Benchell, a diabetes care and education specialist (DCES) and professor of psychiatry and behavioural medicine at the Northwestern University Feinberg School of Medicine, has been among those advocating for focusing on the strengths PWDs bring to their lives, rather than where they may be struggling.
She praises Hilliard’s research for helping to define and quantify the value of building up resilience in PWDs.
“You don’t want to look at anybody as a set of symptoms, as a set of problems,” she said. “That’s just overwhelming, it’s exhausting, and it doesn’t take into account a person’s entire life.”
Weissberg-Benchell has led round tables on resilience and T1D with JDRF, and is currently working with the organization to advance a pilot study of the value of psychological support in paediatric patients and their families after the first year of diagnosis.
She said that an emphasis on positive psychological support has gained many backers in diabetes care, especially as long-promised diabetes technology has failed to bring down average A1C results for people with T1D.
The technology may be wonderful, but if there is something getting in the way of the end user utilizing it to its fullest, then that underlines the need, once again, for psychological support, she said.
“A colleague of mine… says the most expensive device is the one that you buy [at whatever price] and it ends up sitting in the drawer.”
In a small poll about resilience in an online support group for T1D, most of the respondents reported that their healthcare providers tried to focus on their strengths rather than on what’s going wrong during visits. However, beyond this unscientific sampling, too many diabetes-centred social media threads are filled with stories of healthcare providers chastising and even belittling patients. Clearly, there is more work that needs to be done to bring resilience-focused support to the forefront of diabetes care.
One of the stumbling blocks may be insurance coverage, says Hilliard. Currently, insurance payers are reluctant to pay for integrated mental healthcare. When insurance does pay for such services, it usually must come with a diagnosis of what needs fixing, rather than what needs strengthening.
Increased acceptance of the need for psychological support for PWDs is also creating a different problem — a need for more people trained to provide such specialized care.
Hilliard recalls that she and others had to fight to have a dedicated psychologist for mental healthcare for children with diabetes at Texas Children’s Hospital. When that psychologist finally came on board, they were quickly overwhelmed with work, and there is now a long wait list for care.
“There are pipeline issues — not enough people are trained — and then there are funding and access issues as well,” she said.
The major diabetes organizations are working to strengthen the pipeline by creating a directory to help people find psychologists and psychiatrists who are well versed in diabetes issues. They are also offering increased resources to provide diabetes training to people in the mental healthcare fields.
Hopefully, researchers like Hilliard and Weissberg-Benchell can continue to provide quantifiable data that can convince insurers of the value of resilience-based mental health support for PWDs, just as past researchers have done with medtech tools like continuous glucose monitors.
DIABETES symptoms can often go unnoticed for long periods of time because you may not be feeling unusually ill. But, one of the key early warning signs of high blood sugar is developing a strange taste in your mouth. Should you speak to a doctor about type 2 diabetes?
Diabetes is a condition that describes blood sugar levels becoming too high, leading to a series of unwanted complications. But many people live their lives without even knowing they might be at risk. It's essential that you speak to a doctor as soon as possible if you think you could have diabetes.
About 90 percent of all diagnosed diabetes cases are caused by type 2 diabetes.
The condition is caused by the body struggling to produce enough of the hormone insulin, or the body not reacting to insulin. Insulin is required to convert sugar in the blood into useable energy.
However, diabetes symptoms often go under the radar and might be easily dismissed as something less serious.
Some patients first notice that something might be wrong when they develop a strange taste in their mouth.
The taste disturbance can vary, but it's often described as tasting "metallic", according to medical website Healthline. High blood sugar can slowly damage the central nervous system, which subsequently impacts patients' taste and smell. A taste disorder - known as parageusia - might result when the nerves affecting taste are damaged, it said.
"Uncontrolled diabetes or high blood sugar can cause a range of problems such as nerve damage and kidney damage," it said. "But these aren’t the only side effects of diabetes.
"Some people with diabetes may also develop a metallic taste in their mouth. Parageusia is a taste disorder that can occur alongside diabetes. It’s also known to cause a metallic taste in the mouth.
"Simply put, your central nervous system affects how your brain perceives taste, and it’s possible that uncontrolled diabetes can affect your nervous system."
But just because you develop a metallic taste in your mouth, it doesn't necessarily mean that you have diabetes. It could also be caused by indigestion, a cold, or even a sinus infection, according to the NHS.
Gum disease might also lead to an unpleasant taste, which is why it's crucial you regularly brush your teeth and use dental floss.
You should consider speaking to a doctor if the metallic taste doesn't go away, however, and if there's no obvious cause. Meanwhile, you could also be at risk of diabetes if you start using the toilet more often than normal, and if you're feeling unusually thirsty.
Some patients might also have cuts or wounds that take longer to heal, or develop persistently itchy genitals.
Leaving your diabetes undiagnosed could increase the risk of heart disease and strokes.
Speak to a doctor if you're worried about the warning signs of diabetes.
Level of diabetes control correlates with adverse outcomes of COVID-19: experts
It is recommended that persons with diabetes, and associated conditions such as hypertension and heart diseases, take the COVID-19 vaccines as early as possible. These conditions put persons at a higher risk of complications if infected with COVID-19, according to A. Ramachandran, chairman and managing director of Dr. A. Ramachandran’s Diabetes Hospitals (ARH).
Speaking at a webinar on ‘Diabetes Management during COVID-19’ held as a part of The Hindu Wellness Series presented by Diahome and ARH, he said non-COVID-19 medical care was a casualty during the pandemic.
“A large number of patients with chronic diseases such as diabetes, hypertension and heart diseases, who need regular medical care, are suffering due to the pandemic for more than a year. These diseases, especially diabetes, are also age-related and increase the risk of complications and adverse undesirable outcomes in COVID-19 infection,” he said.
It was estimated that about 80% of deaths during COVID-19 were among people with comorbidities such as diabetes, hypertension and heart diseases, he said, adding that their study among 1,000 patients, who were hospitalised for COVID-19 in Chennai, found that mortality was twice as high in diabetics when compared to those without diabetes, and all complications were significantly higher among diabetes patients.
“We also found that the level of control of diabetes was directly correlated with adverse outcomes of COVID-19 infections. Therefore, keeping diabetes under good control during COVID-19 is of utmost importance,” he said.
Nanditha Arun, director and consultant diabetologist, ARH, said higher the HbA1C, which indicates blood glucose level for the three months prior to testing, increases the risk of complications and death due to COVID-19. HbA1C of more than eight indicates poor glycaemic control.
“In previously non-diabetics, there are new manifestations of high glucose that we find in some patients in COVID-19 infections — stress-induced hyperglycaemia and new onset diabetes — which is peculiar,” she said.
As a post COVID-19 recommendation, she said patients with diabetes should check blood glucose regularly, get a good diet plan and start exercise under medical advice.
Arun Raghavan, director and consultant diabetologist, ARH, highlighting the importance of vaccination, said those with diabetes, hypertension and other comorbidities, who were in the high-risk group, should get vaccinated at the earliest.
Elaborating on Diahome (Diabetes Care Comes Home), an app from ARH, he said, it could provide comprehensive diabetes care at home.
